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She is senior editor of Managed Healthcare Executive.
Executives will need to ... craft a whole-person care plan.
National Reports-Since Sherry Huff, 54, from San Antonio, Texas, had bariatric surgery in December 2003, she has lost more than 100 pounds. Aside from the obvious benefits for her-being able to travel easily and walk without pain-Huff also saw an immediate reduction in her healthcare costs.
Prior to her surgery, Huff took 14 pills and three insulin shots per day for high blood pressure, high cholesterol, diabetes and other ailments. Her out-of-pocket medication costs were $500 per month and her insurer paid another $1,000 per month. Six months post-op, Huff takes no medication on a regular basis and the only remaining health condition is asthma. She is convinced that the weight loss is responsible for her not having an asthma attack for six months.
While obesity surgery is expensive-total cost is in the $20,000 to $25,000 range-it begins an almost immediate payoff in terms of direct medical costs, according to John Pilcher, MD, Surgical Consultants of San Antonio. "Patients commonly reduce their medication requirements from 10 to 15 prescription drugs to three or less, and this reduction occurs within six months of surgery," Dr. Pilcher says. "The rate of hospitalization for heart failure, asthma, reflux disease, joint replacement and similar problems is dramatically reduced. The need for ongoing diabetic care almost goes away. In terms of direct medical costs, current estimates place the break-even point at three to five years from surgery."
The recent Medicare legislation that enables Medicare to consider paying for obesity treatments probably will make it necessary, one way or another, for plans to cover effective therapies for obesity.
Eric Parmenter, Midwest region practice leader, compensation and benefits consulting at Grant Thornton LLP, believes there is a danger in opening up coverage for weight-loss treatments such as stomach stapling. "If it is not incorporated into a holistic approach, then the individual will put the weight back on, and it will be a waste of money. Executives need to draw upon other areas of covered expenses, such as treatment for other illnesses and prevention to craft a whole-person care plan that incorporates the new coverage for weight loss," Parmenter says.
Thomas G. Lundquist, MD, executive vice president and chief medical officer at I-trax, a health and productivity company, shares a similar viewpoint. "A public and population health management strategy is needed," Dr. Lundquist says. "Only that would begin to address the growing obesity problem in America, thereby leading to population-based clinical improvement and desired outcomes."
As an alternative to surgery, executives can prepare their plans to investigate the new generation of corporate wellness programs, says Aaron Day, CEO at Boston-based Realize, a corporate weight-loss management company that provides a solution for employees to better manage their health and to be monetarily rewarded for their progress. "The best of these are designed to motivate employees and their spouses ... by measuring, tracking and rewarding employees for achieving and maintaining improved health goals," Day says.
Cognitive behavioral therapy, such as that provided by Selfhelpworks, targets root emotional causes of obesity, says Alan Edwards, Selfhelpworks president. "[Addressing] the root causes, in turn, erases the need for more expensive, symptomology-based treatment options such as surgery," he says. Selfhelpworks is working with WellPoint and government agencies such as the Department of Human Services at the State of Texas to employ such therapies.